Speech-Language Therapy for Primary Progressive Aphasia

Recruiting at 2 trial locations

Overseen by Miguel Ángel Santos Santos, MD, PhD

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Recruiting

Sponsor: University of Texas at Austin

Disqualifiers: Other CNS, psychiatric, visual, others

No Placebo Group

Trial Summary

What is the purpose of this trial?

Difficulties with speech and language are the first and most notable symptoms of primary progressive aphasia (PPA). While there is evidence that demonstrates positive effects of speech-language treatment for individuals with PPA who only speak one language (monolinguals), there is a significant need for investigating the effects of treatment that is optimized for bilingual speakers with PPA. This stage 2 efficacy clinical trial seeks to establish the effects of culturally and linguistically tailored speech-language interventions administered to bilingual individuals with PPA. The overall aim of the intervention component of this study is to establish the relationships between the bilingual experience (e.g., how often each language is used, how "strong" each language is) and treatment response of bilinguals with PPA. Specifically, the investigators will evaluate the benefits of tailored speech-language intervention administered in both languages to bilingual individuals with PPA (60 individuals will be recruited). The investigators will conduct an assessment before treatment, after treatment and at two follow-ups (6 and 12-months post-treatment) in both languages. When possible, a structural scan of the brain (magnetic resonance image) will be collected before treatment in order to identify if brain regions implicated in bilingualism are associated with response to treatment. In addition to the intervention described herein, 30 bilingual individuals with PPA will be recruited to complete behavioral cognitive-linguistic testing and will not receive intervention. Results will provide important knowledge about the neural mechanisms of language re-learning and will address how specific characteristics of bilingualism influence cognitive reserve and linguistic resilience in PPA.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What data supports the effectiveness of the treatment Speech-Language Therapy for Primary Progressive Aphasia?

Research shows that script training, a component of this treatment, is effective for improving speech in people with both stable and progressive aphasia. It helps individuals learn and maintain scripted conversations, with some evidence of improvement in untrained topics and settings. ^{1 2 3 4 5}

Is speech-language therapy, including methods like VISTA and script training, safe for humans?

Research on speech-language therapy methods like VISTA and script training shows they are generally safe for humans, as they involve practicing speech and language skills without any known harmful effects. ^{1 2 3 4 6}

How does the treatment Lexical Retrieval Training (LRT) and Video-Implemented Script Training for Aphasia (VISTA) differ from other treatments for primary progressive aphasia?

This treatment is unique because it combines lexical retrieval training, which focuses on improving word-finding abilities, with script training that helps patients practice and maintain scripted conversations. This approach not only targets word retrieval but also aims to improve sentence production and communication in everyday settings, offering a more comprehensive therapy compared to treatments focusing solely on single-word retrieval. ^{1 7 8 9 10}

Research Team

Stephanie M Grasso, Ph.D.

Principal Investigator

University of Texas at Austin

Miguel Ángel Santos Santos, MD, PhD

Principal Investigator

Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau

Eligibility Criteria

This trial is for bilingual individuals who speak Spanish and Catalan or Spanish and English, diagnosed with Primary Progressive Aphasia (PPA). Participants must have a certain level of cognitive function as measured by the Mini-Mental State Examination. Those with other central nervous system issues, significant sensory impairments, or prominent non-speech-language impairments cannot join.

Inclusion Criteria

I have been diagnosed with Primary Progressive Aphasia.

You score 15 or more on the Mini-Mental State Examination.

Note that this project will also recruit individuals to participate in assessment only, for these individuals the following inclusion criteria applies: Score of 10 or higher on the Mini-Mental State Examination

Exclusion Criteria

Note that this project will also recruit individuals to participate in assessment only, for these individuals the following inclusion criteria applies: Score of less than 10 on the Mini-Mental State Examination

I have a psychiatric condition that causes symptoms.

I have a condition that affects my brain or nerves.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment Phase 1

Participants receive tailored speech-language intervention in both languages for bilingual individuals with PPA

4.5 weeks

Multiple visits for intervention and assessments

Treatment Phase 2

Continuation of speech-language intervention with further assessments

4.5 weeks

Multiple visits for intervention and assessments

Follow-up

Participants are monitored for safety and effectiveness after treatment

12 months

Assessments at 6 months and 12 months post-treatment

Treatment Details

Interventions

• Lexical Retrieval Training (LRT) (Behavioural Intervention)
• Video-Implemented Script Training for Aphasia (VISTA) (Behavioural Intervention)

Trial Overview The study tests two speech-language interventions: Video-Implemented Script Training for Aphasia (VISTA) and Lexical Retrieval Training (LRT), tailored for bilingual speakers with PPA. It aims to understand how bilingualism affects treatment response in PPA over time, including follow-ups at 6 and 12 months post-treatment.

Participant Groups

Group I: Video Implemented Script Training for Aphasia Experimental Treatment 2 Interventions

Script training intervention for individuals with nonfluent/agrammatic PPA.

Group II: Lexical Retrieval Training Experimental Treatment 2 Interventions

Naming intervention for individuals with logopenic or semantic variant PPA.

Who Is Running the Clinical Trial?

University of Texas at Austin

Lead Sponsor

Trials

387

Recruited

86,100+

Hospital Clinic of Barcelona

Collaborator

Trials

441

Recruited

5,417,000+

Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau

Collaborator

Trials

361

Recruited

169,000+

Findings from Research

Script training is an effective therapy for individuals with stable and progressive aphasia, allowing them to learn and maintain scripted speech, with evidence of generalization to untrained topics.

The approach utilizes principles of neuroplasticity and can be adapted to various settings, including individual and group therapy, making it a versatile tool for rehabilitation after brain injuries like stroke.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Can Script Training Improve Narrative and Conversation in Aphasia across Etiology? Hubbard, HI., Nelson, LA., Richardson, JD.[2021]

A study involving eight individuals with chronic non-fluent aphasia demonstrated that using low-difficulty scripts significantly improved oral reading accuracy compared to high-difficulty scripts, regardless of the severity of aphasia.

The results support the effectiveness of using graded script templates tailored to individual abilities, which can enhance communication training for people with aphasia in both clinical and research settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Script Templates: A Practical Approach to Script Training in Aphasia. Kaye, RC., Cherney, LR.[2020]

Script training was effective for individuals with apraxia of speech (AOS), as all three participants successfully acquired and retained their client-selected scripts for up to 6 months after treatment.

Participants reported increased confidence and ease in speaking, indicating that script training not only helped with retention but also improved their overall communication experience.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Script training treatment for adults with apraxia of speech. Youmans, G., Youmans, SR., Hancock, AB.[2016]

The Video-Implemented Script Training for Aphasia (VISTA) significantly improved speech production, accuracy, and intelligibility in a Spanish-English bilingual speaker with aphasia, demonstrating its effectiveness as a treatment method.

Cross-linguistic transfer was observed, meaning improvements in one language also benefited the other; however, using scripts with many cognates reduced this transfer, suggesting that the design of training materials can impact outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Video-Implemented Script Training in a Bilingual Spanish-English Speaker With Aphasia. Grasso, SM., Cruz, DF., Benavidez, R., et al.[2020]

In a meta-analysis of single-case studies involving 142 patients, improvement in the production of treated verbs was linked to pre-treatment scores in verb comprehension and word repetition, as well as the frequency of treatment sessions, suggesting that these factors are crucial for recovery.

For the production of untreated verbs, which involved 166 patients, improvement was associated with the use of morphological cues and the presence of grammatical impairment, indicating that different mechanisms may underlie recovery for treated versus untreated language outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improving Production of Treated and Untreated Verbs in Aphasia: A Meta-Analysis. de Aguiar, V., Bastiaanse, R., Miceli, G.[2020]

The modified script training intervention, which included both in-person and videoconferencing sessions, significantly improved accuracy, grammatical productivity, speaking rate, and articulatory fluency in two individuals with aphasia over a 3-week period for each script.

Participants also demonstrated the ability to generalize their improved skills to functional conversational tasks, indicating that the intervention was effective not only in structured settings but also in real-life communication scenarios.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Script training and generalization for people with aphasia. Goldberg, S., Haley, KL., Jacks, A.[2022]

In a study involving four individuals with Primary Progressive Aphasia (PPA), three participants showed significant improvement in producing treated nouns and verbs after lexical retrieval treatment, indicating the treatment's efficacy.

Two participants with semantic variant PPA demonstrated generalization of treatment effects, improving their use of treated verbs in untreated verb phrases, suggesting that combining noun and verb retrieval strategies may enhance overall language production in clinical settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exploring the effects of verb and noun treatment on verb phrase production in primary progressive aphasia: A series of single case experimental design studies. Taylor-Rubin, C., Nickels, L., Croot, K.[2022]

Lexical retrieval treatments for individuals with primary progressive aphasia (PPA) have shown immediate benefits, with some participants maintaining these gains for months or even years through long-term treatment, based on a review of studies from the 1990s to early 2018.

Five effective behavioral treatment techniques were identified, including standard naming treatment and cueing hierarchies, but there is limited evidence for generalizing these treatments to untreated words, indicating that the focus should be on maintaining a core vocabulary.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Treatment for Lexical Retrieval Impairments in Primary Progressive Aphasia: A Research Update with Implications for Clinical Practice. Croot, K.[2019]

A study involving 20 patients with primary progressive aphasia (PPA) showed that those receiving speech and language therapy (SLT) for 1 hour per week over 11 months had significant improvements in naming ability compared to a control group.

The results indicate that SLT may be beneficial for patients with PPA, warranting further investigation through a randomized, controlled clinical trial to confirm these findings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Speech therapy in primary progressive aphasia: a pilot study. Farrajota, L., Maruta, C., Maroco, J., et al.[2022]

In a study involving 16 individuals with primary progressive aphasia, both verb and noun cueing significantly improved the production of verb phrases compared to no cue, with verb cueing being the most effective method.

Thirteen participants showed notable improvements in verb phrase production with verb cues, suggesting that targeted cueing techniques can enhance treatment outcomes for individuals with aphasia, particularly in verb retrieval.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Is word learning enough? Improved verb phrase production following cueing of verbs and nouns in primary progressive aphasia. Taylor-Rubin, C., Croot, K., Nickels, L.[2021]

References

1. United States pubmed.ncbi.nlm.nih.gov

Can Script Training Improve Narrative and Conversation in Aphasia across Etiology? [2021]

2. United States pubmed.ncbi.nlm.nih.gov

Script Templates: A Practical Approach to Script Training in Aphasia. [2020]

3. United States pubmed.ncbi.nlm.nih.gov

Script training treatment for adults with apraxia of speech. [2016]

4. United States pubmed.ncbi.nlm.nih.gov

Video-Implemented Script Training in a Bilingual Spanish-English Speaker With Aphasia. [2020]

5. Switzerland pubmed.ncbi.nlm.nih.gov

Improving Production of Treated and Untreated Verbs in Aphasia: A Meta-Analysis. [2020]

6. United States pubmed.ncbi.nlm.nih.gov

Script training and generalization for people with aphasia. [2022]

7. England pubmed.ncbi.nlm.nih.gov

Exploring the effects of verb and noun treatment on verb phrase production in primary progressive aphasia: A series of single case experimental design studies. [2022]

8. United States pubmed.ncbi.nlm.nih.gov

Treatment for Lexical Retrieval Impairments in Primary Progressive Aphasia: A Research Update with Implications for Clinical Practice. [2019]

9. Switzerland pubmed.ncbi.nlm.nih.gov

Speech therapy in primary progressive aphasia: a pilot study. [2022]

10. Italy pubmed.ncbi.nlm.nih.gov

Is word learning enough? Improved verb phrase production following cueing of verbs and nouns in primary progressive aphasia. [2021]